What is erectile dysfunction (ED)?

Erectile dysfunction (ED) occurs when a man has repeated problems achieving or sustaining an erection. Without treatment, ED can make sexual intercourse difficult. The condition is sometimes called impotence. Around half of all men between the ages of 40 to 70 in the UK will have some degree of ED. While the topic was once taboo, awareness has skyrocketed with recent advances in treatment for ED.

ED vs. poor libido

There are several forms of male sexual dysfunction, including poor libido and problems with ejaculation. ED refers specifically to problems achieving or maintaining an erection. Men with ED often have a healthy libido, yet the body fails to respond. In most cases, there is a physical basis for the problem.

Symptoms of ED

Symptoms of ED include:

• Erections that are too soft for penetrative sex.
• Erections that don’t last long enough.
• An inability to achieve an erection at all.

These symptoms may occur every time sex is initiated or only some of the time.

Who gets ED?

ED becomes more common as men age, but it is not a part of ageing. Around half of all men between the ages of 40 to 70 in the UK will have some degree of ED. At age 70 and older around seven in 10 men have ED. However, this does not mean growing older is the end of your sex life. ED can be treated at any age.

The mechanics of ED

An erection occurs when blood fills two chambers known as the corpora cavernosa. This causes the penis to expand and stiffen, much like a balloon as it is filled with water. The process is triggered by impulses from the brain and genital nerves. Anything that blocks these impulses or restricts blood flow to the penis can result in ED.

Causes of ED: Chronic disease

The link between chronic disease and ED is most striking for diabetes (depicted here by a blood sugar test). Nearly one out of every two men with diabetes experiences ED. Other conditions that may cause ED include hypertension, cardiovascular disease (atherosclerosis – narrowing of the arteries), Parkinson's disease and multiple sclerosis. These illnesses can impair blood flow or nerve impulses throughout the body.

Causes of ED: Lifestyle

Lifestyle choices that impair blood circulation can contribute to ED. Smoking, excessive drinking and drug abuse may damage the blood vessels and reduce blood flow to the penis. Smoking is a major contributor to atherosclerosis, making men particularly vulnerable to ED. Being overweight and getting too little exercise are other possible risk factors.

Causes of ED: Surgery

Surgery, including treatments for prostate or bladder cancer, can sometimes damage nerves and blood vessels near the penis. In some cases, the nerve damage is permanent, and the patient will require treatment to achieve an erection. In others, surgery causes temporary ED that improves on its own after six to 18 months.

Causes of ED: Medication

ED may be a side effect of medication, including certain blood pressure drugs, antidepressants, tranquilisers and antihistamines. Men should talk to their doctor if they suspect a prescription or over-the-counter medication may be causing erectile problems.

Causes of ED: Psychological

ED usually has something physical behind it, particularly in older men. However, psychological factors may be to blame in 10% to 20% of men with ED. Experts say stress, depression, poor self-esteem and performance anxiety can short-circuit the process that leads to an erection. These factors can also make the problem worse in men whose ED stems from something physical.

ED and cycling

Research suggests avid cyclists suffer more ED than other athletes. Some bike seats have a shape that puts pressure on the perineum. This area between the anus and scrotum contains arteries and nerves vital to sexual arousal. Cyclists who ride for many hours each week may benefit from seats designed to protect the perineum.

Diagnosing ED: Physical examination

To diagnose ED, your doctor will ask you questions about your symptoms and medical history. The doctor will conduct a complete physical examination to uncover signs such as poor circulation or nerve trouble. Your doctor will also look for abnormalities of the genital area that could cause problems with erections.

Diagnosing ED: Lab tests

Several laboratory tests can help diagnose male sexual problems. Measuring testosterone levels can determine whether there is a hormonal imbalance, which is often linked to decreased desire. Blood cell counts, glucose and cholesterol levels, and kidney and liver function tests can reveal medical conditions that may account for ED.

ED: A sign of heart disease?

ED can be a warning sign of more serious disease. A 2010 study suggests ED is a strong predictor of heart attack, stroke and death from cardiovascular disease. The researchers say all men diagnosed with ED should be checked for cardiovascular disease. This does not mean every man with ED will develop heart disease, or that every man with heart disease has ED, but patients should be aware of the link.

Treating ED: Lifestyle changes

Many men with ED are able to improve sexual function by making a few lifestyle changes. Giving up smoking, losing weight and exercising more often can help by improving blood flow. If you suspect a medication could be contributing to ED, talk to your doctor about adjusting your dosage or switching to another treatment.

Treating ED: Medication

You've probably heard of Viagra (sildenafil), but it’s not the only pill for ED. This class of medications also includes Cialis (tadalafil) and Levitra (vardenafil). All work by improving blood flow to the penis during arousal. They're generally taken an hour before sexual activity and should not be used more than once a day. All require an OK from your doctor first for safety.

Treating ED: Injections

While pills for ED are convenient, some men sustain stronger erections by injecting medication directly into the penis. Medications approved for this purpose work by widening the blood vessels, causing the penis to become engorged with blood. Another option is inserting a medicated pellet into the urethra.

Treating ED: Vacuum devices (pumps)

Vacuum devices for ED, also called pumps, offer an alternative to medication. The penis is placed inside a cylinder. A pump draws air out of the cylinder, creating a partial vacuum around the penis. This causes it to fill with blood, leading to an erection. An elastic band worn around the base of the penis maintains the erection during intercourse.

Treating ED: Surgery

If ED is caused by a blockage in an artery leading to the penis, surgery can often restore blood flow. Good candidates are typically younger men whose blockage stems from an injury to the crotch or pelvis. The procedure is not recommended for older men with widespread narrowing of the arteries.

Treating ED: Implants

In men with persistent ED, a penile implant can restore sexual function. An inflatable implant uses two cylinders that are surgically placed inside the penis. When an erection is desired, the man uses a pump to fill the cylinders with pressurised fluid. Another option is a malleable implant, which bolsters erections with surgically implanted rods.

Treating ED: Psychotherapy

Even when ED has a known physical cause, psychotherapy can be beneficial. A therapist can teach the man and his partner techniques to reduce performance anxiety and improve intimacy. Therapy can also help couples adjust to the use of vacuum devices and implants.

Treating ED: Alternative therapies

Talk to your doctor before trying supplements for ED. They may contain ingredients that complicate other health conditions or treatments. 

Treating ED: Buyer beware

A quick web search will reveal dozens of "dietary supplements" that claim to treat ED. However, many of these are not what they seem. Pills often contain prescription medications not listed on the label, including the active ingredient in Viagra. This puts the man at risk of dangerous drug interactions. The regulator MHRA advises men to look out for the Royal Pharmaceutical Society of Great Britain logo to show a website is linked to a registered pharmacy.

ED: Reducing your risk

Some tips to reduce your risk of ED include:

• Exercise and maintain a healthy weight.
• Not smoking.
• Avoiding alcohol and substance abuse.
• Keeping your diabetes under control.

Discussing ED with your partner

It's natural to feel angry or embarrassed when dealing with ED, but don't forget that your partner is also affected. Talking openly about ED will help your partner understand the diagnosis and treatment options. This will reassure your partner that you haven't lost interest.

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